Peptide Interest & Intake Form
Let’s personalize your wellness journey! Please complete the form below so we can help you explore the right peptide therapy options for your goals. At Feelin’ Good Peptide Therapy — where science meets soul. Guided by Dr. Andrew Epstein and powered by a passionate team, we provide personalized, physician-led care to help you feel vibrant, confident, and strong from the inside out. Whether you’re exploring weight loss, peptide therapy, or energy-boosting treatments, we’re here to support your wellness journey every step of the way.
Name & Information
First Name
Last Name
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Email
example@example.com
Phone Number
Please enter a valid phone number.
Preffered Contact Method
Phone
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Email
How did you hear about us?
Your Wellness Goals (check all that apply):
Weight loss/ appetite control
Anti-aging/ longevity
Skin health (glow, elasticity, reduce fine lines)
Hair growth/ hair restoration
Muscle growth/ recovery
Energy boost/ fatigue reduction
Injury healing/ join support
Hormone support/ libido
Immune support
Gut health/ digestion
Mood/ brain clarity
Other
If other, please explain:
Which peptides are you interested in learning more about? (check all that apply):
Semagultide (Weight loss support)
Tirzepatide (Weight loss support)
Retatrutide (Weight loss support)
GHK-Cu (Skin & hair health)
MOTS-C (Metabolic & cognitive wellness, healthy aging/longevity)
NAD+ (Energy, anti-aging, cognitive function)
BPC-157 (Healing, inflammation, gut health)
TB-500 (Injury recovery, muscle support)
Sermorelin (Growth hormone support, anti-aging)
CJC-1295/ Ipamorelin (GH peptide, recovery body composition)
Methylene Blue (Cognitive clarity, energy)
Kisspentin-10 (Hormone balance & perimenopause)
Melanotan II (Tanning)
Tesamorelin (GH support, targeted fat loss)
Bremelanotide PT-141 (Sexual wellness)
The Wolverine Stack
The Anti-aging Stack
The Perimenopause/ Menopause Stack
Other
If you selected other, what are you looking for?
Anything else you would like to share with us before we reach out to you?
By submitting this form, you agree to be contacted by Feelin’ Good Therapy to learn more about how peptides may support your health goals. This form is for educational purposes only and does not replace medical advice. All of our peptides must be approved by our physician. We look forward to connecting with you and learning more about your interests.
By signing below, I consent to the Feelin' Good Therapy contacting me.
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